Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Jaimie Meyer

Abstract

Background: Data is limited on implementation of long-acting injectable (LAI) HIV treatment (ART) and prevention (PrEP). We sought to characterize “early adopters” of LAI ART and PrEP in terms of social determinants of health, using a health equity lens. Methods: A retrospective cohort included patients prescribed ART or PrEP through a large Northeast urban health system (January 2021-September 2023). Separate analyses used electronic health record data for: 1) prevention (LAI vs. oral PrEP) and 2) treatment (LAI vs. oral ART). Group differences were examined using ANOVA, chi-square tests or Fisher’s exact tests. Bivariate logistic regression modeled associations between LAI ART or LAI PrEP, respectively, and social determinants of health. Results: Overall, 238 patients were taking LAI (n=63) and oral (n=193) PrEP. Most PrEP patients were male (80.7%), non-Hispanic (79.5%), white (60.7%) and had public insurance (83.1%). Compared to patients on oral PrEP, those on LAI less often experienced food insecurity, financial strain, depression, anxiety, and substance use disorders. In bivariate models, LAI PrEP inversely correlated with female sex, current smoking, depression, anxiety, and substance use disorder. 1194 patients were prescribed LAI (n=76) and oral (n=1118) ART, with median age 57.0; 63.6% were from minoritized groups. Only age significantly correlated with LAI ART (OR=0.97,95% CI=0.961-0.993, p=0.005), possibly due to small LAI sample size. Conclusion: In this large retrospective cohort of patients on LAI PrEP and ART, patients receiving LAI formulations were more “stable” and healthier. Public health interventions are needed to overcome health inequities tied to access of LAI for HIV prevention and treatment.

Comments

This is an Open Access Thesis.

Download
Open Access

This Article is Open Access

Share

COinS